Tranexamic acid-induced ureteric clot obstruction in a patient with urothelial cell carcinoma resulting in upper urinary tract perforation

Abstract

This is the first report of upper urinary tract (UUT) perforation secondary to tranexamic acid (TXA) induced ureteric clot obstruction. A 77-year-old woman was referred to the urology department with intermittent, painless visible haematuria from a lesion in the right upper calyx, suspicious of urothelial cell carcinoma. She did not have any flank pain or blood clots in her urine. Preoperatively, her haemoglobin level dropped from 113 g/L to 95 g/L and was prescribed oral TXA by her general practitioner, which led to extensive clot formation within the right kidney and ureter resulting in pain and ureteric obstruction. At ureteroscopy, a large ureteric blood clot was extracted and perforation close to the tumour with resultant urinary extravasation was noted. The patient subsequently underwent a successful nephroureterectomy, but risk of potential perforation-related complications such as tumour seeding, sepsis and urinoma formation could have been avoided. TXA in haematuria from the UUT should be strongly discouraged due to the risk of ureteric clot obstruction and UUT perforation.

Safety assessment of tranexamic acid: real-world adverse event analysis from the FAERS database

“…TXA has been linked to ureter perforation and renal cortical necrosis, in line with relevant reports ( Lee et al, 2022 ; Maresca et al, 2022 ). TXA treatment may induce the formation of urinary clots in hematuria patients, leading to secondary ureter perforation and other related adverse reactions, potentially culminating in renal failure ( Lee et al, 2022 ).…”

“…Hemorrhagic rupture is a rare but life-threatening complication of simple hepatic cysts, often presenting with acute abdominal pain (Marion et al, 2013;Simon et al, 2015). Reports suggest that the TXA has been linked to ureter perforation and renal cortical necrosis, in line with relevant reports (Lee et al, 2022;Maresca et al, 2022). TXA treatment may induce the formation of urinary clots in hematuria patients, leading to secondary ureter perforation and other related adverse reactions, potentially culminating in renal failure (Lee et al, 2022).…”